Prevention strategies and modifiable risk factors for concussion: a systematic review and meta-analysis for the Female, woman and girl Athlete Injury pRevention (FAIR) consensus.

Abstract

To examine prevention strategies and potential modifiable risk factors (MRFs) for sport-related concussion (SRC) and head impact/head acceleration event (HAE) outcomes in female, woman and/or girl athletes. Systematic review with meta-analyses and Grading of Recommendations, Assessment, Development and Evaluation. Medline, CINAHL, PsycINfo, SportDiscus, ERIC, CENTRAL and CDSR. Primary data studies with comparison group(s) assessing the association of prevention interventions and/or MRFs for SRC or HAE with ≥1 female/woman/girl in each study group. Of the 108 included studies, 67 evaluated a SRC prevention strategy (equipment n=25, policy/rule n=21, training n=10, management n=11) and 41 evaluated potential MRFs (34 distinct MRFs across nine categories). In total, 40/108 (37%) studies (prevention 19/67; MRF 21/41) included female/woman/girl-specific estimates. Three meta-analyses were conducted: two SRC prevention strategies (headgear, eyewear) and one MRF (artificial turf vs grass) based on availability of female/woman/girl-only estimates and similar outcomes and exposure. Headgear was associated with 30% lower SRC rates in adolescent female/girl lacrosse and soccer (IRR=0.70, 95% CI 0.50 to 0.99; very-low certainty). Eyewear use was not protective for SRC (IRR=1.08, 95% CI 0.69 to 1.68; very-low certainty). SRC rates did not differ by artificial turf versus grass (IRR=0.95, 95% CI 0.62 to 1.45; very-low certainty). We found limited evidence for prevention strategies and MRFs in female/woman/girl athletes except for very-low certainty evidence supporting headgear use in adolescent lacrosse and soccer. Future studies should consider the design, implementation and evaluation of SRC prevention strategies that target MRFs to guide safe practice recommendations specifically for female/woman/girl athletes.